Evidence is lacking on best practices for community-engaged translational research in rural communities with underserved, multiethnic and vulnerable populations. Living in rural America is associated with health disparities that are not seen in urban areas (e.g., higher rates of accidental injury, cardiovascular disease, cancer and suicide).1 Rural populations are poorer and have less access to health care and mental health services. According to the U.S. Census Bureau, 19% of the country’s population is rural.2 In New Mexico, however, 60% of the population lives in rural communities. Furthermore, 30 out of the 33 counties are designated Health Professional Shortage Areas.3 These vulnerable rural populations need to be represented in clinical and translational research, but methods to engage rural providers and community populations in translational research are not well defined.
Rural health disparities affect people across the nation; the Rural Health Research Support Network (RHRSN) was developed to have a broader impact than focusing solely on New Mexico. This network includes multiple Clinical and Translational Science Award (CTSA) Program hubs across the United States with a goal of building research collaborations to address rural health priorities and accelerate clinical and translational research best practices in rural communities. The network aims to deliver rapid-response, best-practice methodology to conduct translational research in rural, underserved, multiethnic populations. The objective of the RHRSN is to support multisite studies in rural populations, test best practices for rural community engagement, and disseminate lessons learned to the larger CTSA collaborative and the public.
Current core partners in the RHRSN are the Universities of New Mexico, Kansas, Kentucky, North Carolina, and Utah. Housed at the UNM Clinical and Translational Science Center (CTSC), the RHRSN program manager and national point of contact coordinates the committee and committee meetings, responds to inquiries, facilitates network collaborations, and serves as the research manager for local RHRSN projects. The network offers numerous services to assist with multisite rural health research, including consultation and training, connecting with communities, integrating special populations, mixed-methods data collection and analysis, capacity building, information dissemination, project management, research coordination, regulatory support, medical and laboratory tasks, and Spanish-English interpretation and translation.
As expected, working with numerous institutions and people presents challenges. In the beginning of the network, the RHRSN program manager at the UNM CTSC. had to coordinate busy schedules, align visions, and determine services and associated fees. Now that the network and service core are established, the administrative lead for the RHRSN continues to experience difficulty in reaching out to investigators who may be interested in using RHRSN; identifying projects that work for multiple researchers with different interests, disciplines, schools and regions; coordinating busy schedules; and identifying and receiving funding.
The network has had notable successes. Twenty faculty and staff members nationwide are involved in the oversight of network activities and developing partnerships and expanding rural health research across our states. Through these key players, the RHRSN has received expressions of interest in potential collaborations from more than 60 researchers from across our network universities and beyond. Five other projects associated with the RHRSN are in development that will study diabetes prevention, cancer survivorship, social determinants of health, opioid stewardship and precision medicine.
The first RHRSN feasibility project is being implemented across four states, looking at Acceptance and Commitment Therapy as a behavioral approach to treating chronic non-cancer pain and reducing chronic opioid use. North Carolina PI Jacquie Halladay, M.D., M.P.H., says, “The needs of rural citizens and the medical practices that serve them are great and often unique. With the many pressing issues of the day, we must continue to work collaboratively to understand how to enhance outcomes for people living in rural settings. The network infrastructure allowed us to engage in a pilot project across four CTSA Program hubs…This allowed for the creation of many new processes in an applied manner. For instance, we were able to learn how to use a single Institutional Review Board [IRB] (the first one at UNM), how to enhance our skills in file sharing, and use of survey instruments using REDCap. The pilot work has taught us many important lessons that should enhance our efficiency at conducting a larger multisite effectiveness trial.”
The RHRSN network encourages collaboration with more investigators, CTSA Program hubs and universities. If you are interested in learning more about RHRSN or connecting with the network, please visit our website and email the RHRSN Program Manager, Heidi Rishel Brakey, at firstname.lastname@example.org. The RHRSN network looks forward to working with you!
- National Rural Health Association: www.ruralhealthweb.org/about-nrha/about-rural-health-care
- U.S. Census Bureau (2010). American Fact Finder. Urban and Rural; Universe: Total population; 2010 Census Summary File 1. factfinder2.census.gov.
- Kaufman, A., W. Powell, C. Alfero, et al. 2010. “Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease.” Ann Fam Med 8 (1): 73–81.